Erratum: "Eating and Nutrition Habits in Young Competitive Athletes: A Comparison Between Soccer Players and Cyclists".

[This corrects the article on p. 44 in vol. 11, PMID: 25674549.].

Changes in hydration, body-cell mass and endurance performance of professional soccer players through a competitive season.

AIM: The aim of this paper was to determine changes of the bioelectrical impedance vector (BIVA) throughout a soccer season and to ascertain whether vector changes are associated with endurance performance changes. METHODS: Eighteen professional male soccer players (age=21.8±3.0 years, height=1.8±0.07 m, mass=7.2±6.5 kg) participated in the study. BIVA was conducted serially on 8 occasions throughout one soccer season. Endurance performance (Yo-Yo test) was assessed before the first training session of the preseason training, after the pre-season training and at the end of the season. RESULTS: Vector length shortened (p<0.05) during pre-season training and was associated with improvements in endurance performance (r=0.569, p=0.034). Vector length and phase-angle increased at mid-season compared to post pre-season training (p<0.05). Vector length at end-season was lower compared to mid-season (p<0.05). No further changes in endurance performance occurred. CONCLUSION: Bioimpedance vector variations from baseline indicate that fluid-gains occur during the pre-season training, possibly due to plasma volume expansion and enhanced glycogen storage, accompanied by improvements in endurance performance. The vector migration and the increase in phase angle during the competitive season indicate fluid-loss and an increase in body cell mass without effects on performance. At the very end of the season, when training volume and intensity are reduced, body fluid increases again.

Lifestyle and eating habits in a business community.

PURPOSE: The present study verified, using a validated questionnaire, the presence of unhealthy aspects of lifestyle and chronic degenerative conditions in a working community. METHODS: A cohort from a working community in Italy was investigated using of the INRAN (Istituto Nazionale di Ricerca per gli Alimenti e Nutrizione) questionnaire dedicated to the eating habits and Physical Activity Stages of Change. RESULTS: Most of the 93 subjects (56 females and 37 males, aged 42.0±0.7) recruited reported low levels of physical activity (70 subjects). Slightly more than 50% of the subjects undertook physical activity more than once a week, while 13% did it only once. Food intolerances were reported by 7 subjects (8%), with a high consumption of fruits, cereals and dairy products, low consumption of fish and alcohol, and meat consumption in the normal range. There was a high satisfaction in general quality of life. CONCLUSION: Questionnaire investigations play a role to identify the presence of degenerative chronic conditions in working communities. The self-reported perception of quality of life does not necessarily agree with the lifestyle habits found. Awareness of this aspect could be helpful to plan lifestyle interventions and promote healthy living habits.

Implantable cardioverter defibrillator in sport participation.

Although athletic participation lowers cardiovascular risk and improves quality of life, it may represent a hazard in high-risk group athletes such as those with cardiac abnormalities receiving an implantable cardioverter defibrillator (ICD). ICD sports participants are exposed to the potential risk of inappropriate shocks due to sinus tachycardia and other supraventricular arrhythmias during exertion as well as device injury. The safety of athletic participation of ICD-patients is not completely defined and ICD efficacy in interrupting malignant arrhythmias during intense exercise is partly unknown. This explains difficulties in current recommendations made by physicians, given the associated potentially ischemic, autonomic and metabolic conditions. The scope of this review is to underline specific considerations including potential risks and recommendations for athletic participation in this patient-group.

Which factors predict the behavior of ventricular extrasystoles in athletes over time?

Spontaneous behavior of ventricular extrasystoles (VE) was analysed. From a database containing 578 athletes with VE, 84 males and 11 females (29.9 ± 18.1 years) having ≥ 100 VE or repetitive VE [ventricular couplets (VC) or ventricular tachycardias (VT)] at first 24-hour Holter electrocardiographic monitoring (24-h-HM) (baseline) and at least 1-year of follow-up (3.1 ± 2.2 years) over the past 10 years were selected. The baseline was compared with the last 24-h-HM to establish DVE (VE reduction of at least 98%/24 h in the absence of VC or VT). SDVE was calculated as standard deviation of the number of VE on serial 24-h-HMs. DVE and SDVE were considered as dependent variables. Independent variables were: age, sex, type of sport, symptoms, baseline VE rate (BVE), baseline VC and VT, VE morphology, VE behavior during the baseline training session, disqualification from competitive sports, echocardiographic abnormalities. DVE occurred in 32 athletes (34%). SDVE varied from 0 to 12,658 VE/24 h (1916 ± 2649.9). Disappearance of VE during the baseline training session (DVET) correlated to DVE (P = 0.0319). BVE directly correlated to SDVE (P = 0.0008). Athletes' VE are highly variable over time, their variability depending on BVE, and they not infrequently tend to disappear. The only useful variable for predicting DVE is DVET.

Atrial fibrillation in athletes.

Many studies have shown a relationship between long-term endurance sport practice and atrial fibrillation. Inflammation, anatomic remodelling, alterations in the autonomic system and neurohormonal activation are all possible explanations for the increased prevalence of this arrhythmia in athletes. Atrial fibrillation may determine disabling symptoms like palpitations and impaired physical performance, compromising eligibility for competitive activities, but exclusion from sport is not necessary for all athletes. Limited data are available on drug therapy and recently ablation resulted to be a particularly attractive option for young athletes with paroxysmal atrial fibrillation. The purpose of this review is to discuss mechanisms, clinical features, management of atrial fibrillation in competitive athletes, including criteria for eligibility and disqualification in sport practice.

Photoresponses of the compound eye of the sandhopper Talitrus saltator (Crustacea, Amphipoda) in the ultraviolet-blue range.

The semi-terrestrial sandhopper Talitrus saltator uses celestial visual cues to orient along the sea-land axis of the beach. Previous spectral-filtering experiments suggested that it perceives directional information from wavelengths in the ultraviolet (UV)-blue range. Binary choice experiments between dark and UV (380-nm) light carried out on dark-adapted individuals of T. saltator showed photopositive movement to UV. Morphologically, each ommatidium in the eye consists of five retinula cells, four large and one small. In electroretinogram experiments, sensitivity of the dark-adapted eye is dominated by a receptor maximally sensitive at about 390-450 nm and secondarily sensitive at about 500-550 nm. Selective light-adaptation experiments at 580 nm showed the apparent sensitivity decreasing at around the secondary sensitive range, thus disclosing the existence of UV-blue photoreceptor cells. Here the existence of UV-blue detection is confirmed, and evidence is provided that green and UV-blue visual pigments are located in the large and small retinula cells, respectively.

Hemangiopericytoma-solitary fibrous tumour of soft tissue: description of a case showing atypical histological features.

Extrathoracic solitary fibrous tumours have been reported in almost all anatomic sites, but reports of tumours in the extremities or in intramuscular locations, as well as of tumours with atypical histological features and malignant behaviour, are rare. Herein the authors describe a case of hemangiopericytoma-solitary fibrous tumour that arose in the gluteal region of a 47-year-old woman. The tumour showed atypical histological features, such as high cellularity, increased mitotic activity and focal expression of cytokeratins.

Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation.

OBJECTIVE: In this study, the impact of regular training on left ventricle morphology in a group of athletes with bicuspid aortic valve (BAV) was evaluated. DESIGN: Longitudinal cohort study. A group of competitive athletes with BAV was followed up with a yearly standard echocardiographic examination for 5 years. SETTING: Sport Medicine Centre, University of Florence, Pre-Participation Protocol Study. PARTICIPANTS: A group of 88 consecutive athletes diagnosed with BAV was identified in the period January to December 1999, and 30 of these completed a 5-year follow-up. They were compared with a group of 56 athletes with a normal tricuspid valve (TAV). RESULTS: BAV athletes showed significant progressive increase in left ventricular dimensions and aortic diameters at four levels. The values were within the range of the general and non-athletic BAV populations. In TAV athletes, the aortic and left ventricle dimensions did not increase significantly and remained within physiological range. CONCLUSIONS: Left ventricular dimensions in competitive BAV athletes remain within the normal range. There is, however, a significant progressive increase in the BAV group compared with the TAV group. These results are in agreement with data obtained in previous studies on the non-athletic BAV population. Sports activity does not have an additional effect on cardiac morphology in athletes with asymptomatic BAV associated with mild regurgitation, for at least 5 years.

Epithelioid angiomyolipoma of the kidney: case report.

Renal angiomyolipoma is a benign tumour histologically characterized by a mixture of adipose tissue, smooth muscle cells and thick walled blood vessels. Long-believed to be a benign hamartoma, angiomyolipoma is now considered to arise from perivascular epithelioid cells. Epithelioid angiomyolipoma is a rare type of angiomyolipoma, composed partially or completely of epithelioid cells, with a potentially aggressive behaviour. Histologically it can mimic renal cell carcinoma. Positivity for HMB45, Melan A, CD68 and CD117 are useful for diagnosis. Herein, we report the clinicopathologic and immunohistochemical features of a renal tumour composed of large epithelioid mononucleated or multinucleated cells with abundant acidophilic cytoplasm and prominent nucleoli. Despite the morphologic resemblance of this tumour to renal cell carcinoma, its phenotype (HMB45, Melan A and CD68 positivity and keratin negativity) parallels the phenotypic profile of angiomyolipoma. Therefore, immunohistochemistry should be considered when diagnosing this variant of angiomyolipoma.

The cardiovascular profile of soccer referees: an echocardiographic study.

BACKGROUND: During a soccer game, the cardiovascular system is severely taxed The referees must be alert and their level of fitness must be such that fatigue will not impair their decision-making. Referee's peak overall performance is usually after 40 when the performance starts to decline. We evaluated the morphological and functional cardiac profile of professional soccer referees. MATERIALS AND METHODS: We submitted to a clinical and echocardiographic exam a group of 120 professional soccer referees aged 25 - 45 years, including the first division of the Italian Championship, matched with 120 soccer players, including élite soccer players. Data were compared using an unpaired Student's t test. Statistical significance was with p < 0.05. RESULTS: Right ventricle dimensions (22.2 +/- 3.8 vs 25.9 +/- 2.4 mm) and Left Ventricular Mass Index (LVMi) (100.5 +/- 45.2 vs 105.4 +/- 17.3) were significantly greater in referees than in active soccer players. Left atrium dimensions (33.7 +/- 8.9 vs 36.2 +/- 3.1 mm), aortic root (29.7 +/- 7.9 vs 32.1 +/- 3 mm) and LVMi (115.1 +/- 16.7 vs 134.1 +/- 19.9 g/m2) were significantly greater in élite soccer players than in first-division referees. CONCLUSION: Our investigation shows that right ventricle is greater in referees than in soccer players. The differences (left atrium, aortic root and LVMi) between first division referees and élite soccer players may derive from the different training workloads.

Bicuspid aortic valve in competitive athletes.

AIM: Bicuspid aortic valve (BAV) is a common congenital cardiac condition. The presence of BAV in non-elite athletes has been poorly investigated; it is usually asymptomatic until valvular stenosis, regurgitation or other vascular alterations are evident. DESIGN: Over a three-year period, 2273 competitive athletes were consecutively investigated with transthoracic echocardiography. The traditional parameters, the aortic root dimensions at four levels and the systolic and diastolic flow of aortic valve, were studied with continuous Doppler according to the echo guidelines. SETTING: The study protocol included all the non-elite athletes investigated for the first evaluation to obtain eligibility. PATIENTS: 2273 competitive athletes aged 8-60 years from several sports and regularly trained were evaluated with anamnesis, clinical check-up and echocardiography in order to exclude subjects with systemic or congenital heart disease. RESULTS: BAV was diagnosed in 58 athletes (2.5%). Of these, nine had normal valvular function, 47 had abnormal valvular function with mild-moderate aortic regurgitation, and two had moderate stenosis. Aortic root dimensions at all levels were significantly greater in athletes with BAV than in athletes with a normal tricuspid valve. No relation was found with age, body surface area, aortic regurgitation or years of training. CONCLUSIONS: BAV is a relatively common congenital cardiac disease in athletes and commonly asymptomatic for a long time. This study suggests the usefulness of evaluating young athletes using echocardiography at least once when they start their sporting activity.

Increased cardiac sympathetic activity and insulin-like growth factor-I formation are associated with physiological hypertrophy in athletes.

Physiological hypertrophy represents the adaptive changes of the heart required for supporting the increased hemodynamic load in regularly trained healthy subjects. Mechanisms responsible for the athlete's hypertrophy still remain unknown. In 15 trained competitive soccer players and in 15 healthy men not engaged in sporting activities (sedentary control subjects) of equivalent age, we investigated the relationship among cardiac growth factor formation, cardiac sympathetic activity, and left ventricular morphology and function. Cardiac formation of insulin-like growth factor (IGF)-I, endothelin (ET)-1, big ET-1, and angiotensin (Ang) II was investigated at rest by measuring artery-coronary sinus concentration gradients. Cardiac sympathetic activity was studied by [(3)H]norepinephrine (NE) kinetics. Cardiac IGF-I, but not ET-1, big ET-1, and Ang II, formation was higher in athletes than in control subjects (P<0.01). NE levels in arterial and peripheral venous blood did not differ between groups. In contrast, coronary sinus NE concentration was higher in athletes than in control subjects (P<0.01). Cardiac, but not total systemic, NE spillover was also increased in athletes (P<0.01), whereas cardiac [(3)H]NE reuptake and clearance were not different. Echocardiographic modifications indicated a volume overload-induced hypertrophy associated with increased myocardial contractility. Multivariate stepwise analysis selected left ventricular mass index as the most predictive independent variable for cardiac IGF-I formation and velocity of circumferential fiber shortening for cardiac NE spillover. In conclusion, increased cardiac IGF-I formation and enhanced sympathetic activity selectively confined to the heart appear to be responsible for the physiological hypertrophy in athletes performing predominantly isotonic exercise.

RAS genes influence exercise-induced left ventricular hypertrophy: an elite athletes study.

PURPOSE: The association of ACE I/D polymorphism with changes in LV mass in response to physical training has been observed, but no association has been found with AT1R A1166C polymorphism. We investigated the ACE I/D, AT1R A1166C, and AT1R CA microsatellite polymorphisms genotype distribution in elite athletes and whether the presence of AT1R C1166 variant, in addition to ACE D allele affects the training-induced LV mass alterations in elite trained athletes. METHODS: The study population comprised 28 healthy players recruited from an Italian elite male soccer team and 155 healthy male subjects. LV mass, LV mass adjusted for body surface area, septal thickness, posterior wall, end-diastolic and end-systolic ventricular dimension, and ejection fraction were determined by echocardiography in pretrained period, at rest and 7 months later during the training. All subjects were genotyped for ACE I/D, AT1R A1166C, and CA microsatellite polymorphisms. RESULTS: Training induced an LV mass increase in all but six athletes. The percentage of athletes in whom an increase of LV mass was found after training was statistically different in relation to the ACE D allele: no increase was observed in three of 24 D allele carriers and in three of four II genotype players (Fisher's exact test, P = 0.02). As AT1R is concerned, no increase was observed in 4 of 15 C allele carriers and in 2 of 13 AA genotype athletes (Fisher's exact test, P > 0.05). The contemporary presence of ACE D and AT1R C allele did not affect the changes after training. No difference has been observed in the CA microsatellite marker allele frequencies between athletes and controls (P = 0.46). CONCLUSION: In this study, we provide the evidence that soccer play does not select athletes on genotype basis. Training-induced LV mass changes in male elite athletes are significantly associated with the presence of ACE D allele, but not of AT1R C allele.

Renal endothelin in heart failure and its relation to sodium excretion.

BACKGROUND: Recent studies have shown that endothelin-1 (ET-1) antagonists increase sodium excretion and improve renal blood flow in experimental heart failure (HF). However, despite a number of investigations that have reported a significant increase in ET-1 plasma levels in patients with HF, it is still not known whether increased renal synthesis and urinary excretion of ET-1 occur. Our aim was to investigate renal ET-1 formation and its relation to sodium excretion in patients with HF. METHODS: One hundred forty-seven patients with HF, subdivided according to New York Heart Association (NYHA) functional classes, and 28 healthy controls were studied. ET-1 and big ET-1 were measured in plasma and in 24-hour urine by radioimmunoassay. Atrial and brain natriuretic peptide, arginine vasopressin, plasma renin activity, and hemodynamic variables were also investigated. RESULTS: Urinary ET-1 excretion was already increased in NYHA class II patients (P <.001 vs controls), whereas plasma ET-1 increased only in NYHA class III and IV patients (P <.001). In the 71 subjects who were not receiving diuretic treatment, urinary ET-1 was selected as the strongest predictor of sodium excretion by multivariate stepwise analysis. CONCLUSIONS: Urinary ET-1 excretion increases in an earlier phase of HF than plasma ET-1 and appears to be closely correlated with sodium excretion, indicating renal ET-1 is a target for ET-1 antagonists in patients with HF.

Early sequence of cardiac adaptations and growth factor formation in pressure- and volume-overload hypertrophy.

To investigate the time sequence of cardiac growth factor formation, echocardiographic and hemodynamic measurements were performed at scheduled times, and mRNAs for angiotensinogen, prepro-endothelin-1 (ppET-1), and insulin-like growth factor I (IGF-I) were quantified with RT-PCR and localized with in situ hybridization in pigs (fluothane anesthesia) by use of pressure or volume overload (aortic banding and aorta-cava fistula, respectively). Relative peptide formation was also measured by radioimmunoassay. In pressure overload, angiotensinogen and ppET-1 mRNA overexpression on myocytes (13 times vs. sham at 3 h and 112 times at 6 h, respectively) was followed by recovery (12 h) of initially decreased (0.5-6 h) myocardial contractility. In volume overload, contractility was not decreased, the angiotensinogen gene was slightly upregulated at 6 h (6.7 times), and ppET-1 was not overexpressed. IGF-I mRNA was overexpressed on myocytes (at 24 h) in both volume and pressure overload (14 times and 37 times, respectively). In the latter setting, a second ppET-1 overexpression was detectable on myocytes at 7 days. In conclusion, acute cardiac adaptation responses involve different growth factor activation over time in pressure versus volume overload; growth factors initially support myocardial contractility and thereafter induce myocardial hypertrophy.